主动脉经瓣梯度量化错误。

IF 1.3 Q3 ANESTHESIOLOGY
Annals of Cardiac Anaesthesia Pub Date : 2025-07-01 Epub Date: 2025-07-08 DOI:10.4103/aca.aca_10_25
Marco Modestini, Jan A Krikken, Geertje Jansma, Wobbe Bouma, Jayant S Jainandunsing
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引用次数: 0

摘要

摘要:二尖瓣反流(MR)在超声心动图多普勒成像中偶尔会模拟主动脉瓣狭窄(AS),这给诊断带来了挑战。我们提出的情况下,55岁的男子接受微创二尖瓣手术严重的MR后二尖瓣小叶脱垂引起的。术前经胸超声心动图显示严重MR,无明显主动脉瓣异常。术中经食管超声心动图(TEE)最初显示经胃长轴位高瓣主动脉梯度(3m /s),提示轻至中度AS。然而,详细的多普勒分析显示双包膜信号,代表偏心MR和真主动脉瓣血流。进一步的评估显示MR信号出现在心脏周期的早期,与其血流动力学时间一致,而真正的主动脉流量跟随等容收缩。随后的三维TEE证实主动脉瓣形态和功能正常。本病例强调了术前表现、多普勒信号时间和影像学资料相关联以避免误诊的重要性。系统超声心动图评估,包括信号时序分析,可以区分MR和AS,确保准确的术中决策,防止不必要的干预。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Aortic Transvalvular Gradient Mis-Quantification.

Abstract: Mitral regurgitation (MR) can occasionally mimic aortic stenosis (AS) on echocardiographic Doppler imaging, leading to diagnostic challenges. We present the case of a 55-year-old man undergoing minimally invasive mitral valve surgery for severe MR caused by posterior mitral valve leaflet prolapse. Preoperative transthoracic echocardiography revealed severe MR with no significant aortic valve abnormalities. Intraoperative transesophageal echocardiography (TEE) initially showed a high transvalvular aortic gradient (3 m/s) in the transgastric long-axis view, suggestive of mild-to-moderate AS. However, detailed Doppler analysis revealed a double envelope signal, representing both eccentric MR and true aortic valve flow. The closer evaluation showed the MR signal occurred earlier in the cardiac cycle, aligning with its hemodynamic timing, while the true aortic flow followed isovolumetric contraction. Subsequent three-dimensional TEE confirmed normal aortic valve morphology and function. This case highlights the importance of correlating preoperative findings, Doppler signal timing, and imaging data to avoid misdiagnosis. Systematic echocardiographic evaluation, including signal timing analysis, can differentiate between MR and AS, ensuring accurate intraoperative decision-making and preventing unnecessary interventions.

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来源期刊
CiteScore
1.60
自引率
0.00%
发文量
147
审稿时长
26 weeks
期刊介绍: Annals of Cardiac Anaesthesia (ACA) is the official journal of the Indian Association of Cardiovascular Thoracic Anaesthesiologists. The journal is indexed with PubMed/MEDLINE, Excerpta Medica/EMBASE, IndMed and MedInd. The journal’s full text is online at www.annals.in. With the aim of faster and better dissemination of knowledge, we will be publishing articles ‘Ahead of Print’ immediately on acceptance. In addition, the journal would allow free access (Open Access) to its contents, which is likely to attract more readers and citations to articles published in ACA. Authors do not have to pay for submission, processing or publication of articles in ACA.
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